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Consumer Complaint Form

Consumer complaints may only be filed by parties involved in the insurance contract. If you are unsure if you are an involved party; if your complaint involves an insurance matter or if the State of Idaho has jurisdiction, please contact us at 208-334-4319.

Your Contact Information
* Denotes required fields

Name First *
Middle
Last *

Address*
City*
State*
Zip*

Phone *
Alternate Phone
Email


   
   

   
   
     
     

   
   
How would you prefer we correspond with you?
     


Insurance Information

Complete name of Insurance Company involved

Is this a group policy?
     

Name of the policyholder or defendant if different than your name

Policy Number
Claim Number
Date Loss Occurred
 

Does your complaint concern an Insurance Agent, Bail Agent or Title Agent?
     

Other Information

Have you previously written to the Department of Insurance about this matter?
     

Have you reported this matter to another governmental agency?
     

Do you have an attorney representing you?
     
Is there a court action pending?
     

Complaint Information

Please describe the reason(s) for your complaint below (if you require more space than allowed in this box, please consider using the attach documents feature below)   *
 
2500 Char Max

What do you consider to be a fair resolution to your complaint/problem?   *
 
2500 Char Max


Please check if you have Attachments to send to us.

I am the person named above. To the best of my knowledge, the information contained herein is true and accurate. I understand that copies of this information and any documentation I have supplied may be sent to the party or parties complained about as part of Idaho’s Department of Insurance investigation, or to any other State or Federal Agency that may be able to assist me. Please check the box below to indicate that you agree to the statements in this paragraph.

I Agree (NOTE: BEFORE SUBMITTING INFORMATION YOU MUST READ AND AGREE TO THE ABOVE STATEMENT.)

If you would like a copy of your complaint please PRINT it before hitting the “Submit Complaint” button. Please click on Submit Complaint only once, and wait patiently. It may take some time for our system to process your entry. You will receive a confirmation if the form has successfully completed.